A Florida-based pharmacy, OHM Pharmacy Services, agreed to plead guilty to one count of healthcare fraud, pay $82,000 in restitution and pay an additional $1 million to resolve allegations of violating the False Claims Act, according to an April 10 news release from the Justice Department.
What happened?
- OHM Pharmacy Services admitted to improperly handling prior authorization forms for Evzio, a costly medication used to treat opioid overdoses. Due to its high price, insurers typically require physicians to submit prior authorization documentation before approving coverage.
- Instead of allowing physicians to complete these forms, OHM staff filled them out — and in some cases, signed them without the physicians’ knowledge or consent. The pharmacy also took steps to make it appear that the forms had been submitted by the physicians themselves, rather than OHM.
- Further, OHM submitted false information to insurers, including Medicare. For instance, the pharmacy falsely claimed that some patients had unsuccessfully tried alternative overdose treatments, such as Narcan, when they had not.
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